Child Maltreatment and Mortality in Young Adults

Abstract

BACKGROUND: Child maltreatment (CM) is a global public health issue, with reported impacts on health and social outcomes. Evidence on mortality is lacking. In this study, we aimed to estimate the impact of CM on death rates in persons 16 to 33 years. METHODS: A retrospective cohort study of all persons born in South Australia 1986 to 2003 using linked administrative data. CM exposure was based on child protection service (CPS) contact: unexposed, no CPS contact before 16 years, and 7 exposed groups. Deaths were observed until May 31, 2019 and plotted from 16 years. Adjusted hazard ratios (aHRs) by CPS category were estimated using Cox proportional hazards models, adjusting for child and maternal characteristics. Incident rate ratios (IRRs) were derived for major causes of death, with and without CPS contact. RESULTS: The cohort included 331 254 persons, 20% with CPS contact. Persons with a child protection matter notification and nonsubstantiated or substantiated investigation had more than twice the death rate compared with persons with no CPS contact: aHR = 2.09 (95% confidence interval [CI] = 1.62–2.70) to aHR = 2.61 (95% CI = 1.99–3.43). Relative to no CPS contact, persons ever placed in out-of-home care had the highest mortality if first placed in care aged ≥3 years (aHR = 4.67 [95% CI = 3.52–6.20]); aHR was 1.75(95% CI = 0.98–3.14) if first placed in care aged <3 years. The largest differential cause-specific mortality (any contact versus no CPS contact) was death from poisonings, alcohol, and/or other substances (IRR = 4.82 [95% CI = 3.31–7.01]) and from suicide (IRR = 2.82 [95% CI = 2.15–3.68]). CONCLUSIONS: CM is a major underlying cause of potentially avoidable deaths in early adulthood. Clinical and family-based support for children and families in which CM is occurring must be a priority to protect children from imminent risk of harm and early death as young adults.

Adult mortality in children exposed to state care: systematic review and meta-analysis of prospective cohort studies

“…However, that several of the published studies controlled for childhood socioeconomic circumstances 10,26,45 and our own analyses of the two birth cohort studies took into account an array of early life adversities (e.g., physical neglect, family history of mental illness/substance abuse) would tend to suggest that there is some risk specifically due to the care experience. It is also the case that removal from care is not universally due to childhood experience of neglect, rather, substitute care may be required because the biological parents are unable to cope with a child's anti-social behaviour.…”

“…10 Three studies used the general population as an external comparator group, 23,24,42 while the remaining five featured internal comparators where children were exclusively unexposed to state care. 10,26,[43][44][45] Six studies were generated solely from linkage of participants to population registers, 10,23,24,26,42,43 and four were field-based such that care status was reported by parent or study member (two published, 44,45 two unpublished). Where the number of people in the study sample with a history of care during childhood was reported relative to the population at risk, the prevalence ranged between 1% 43 and 9%.…”

“…Three studies were drawn from the Swedish population, 24,25,43 and one each from Canada 42 and Finland 23 (table 1). This material comprised 1,524,761 individuals (sample size range: 13100 24 and 487,948 25 ) born between 1962 42 and 2003, 26 the maximum age at follow-up being 39 years. 25 In all studies, care was associated with higher rates of completed suicide, however, effect estimates were less heterogeneous (I 2 = 68%, p-value 0.005) and larger than those apparent in analyses of total mortality, such that the pooled rate ratio suggested a person with experience of care in childhood had a more than three-fold risk of taking their own life in adulthood (3.48; 2.61, 4.64).…”

Association of Child Maltreatment With Risk of Death During Childhood in South Australia

“…3 The consequences of child maltreatment are considerable and can be lifelong. 4,5 Associations of child maltreatment with mental and physical health, including with increased risk for attempted (and completed) suicide, [6][7][8] mental illness, and addiction disorders 8,9 and higher rates of hospitalization, 10 have been widely documented.…”

How Can I Feel Safe at Home? Adolescents' Experiences of Family Violence in Ghana

“…For instance, in 2015 alone, 119,000 children and adolescents (10–19 years) died from violent deaths globally ( 4 ). Child maltreatment at the family level has also been associated with unwanted pregnancies, depression, anxiety, and post-traumatic stress disorder ( 5 , 6 ), cognitive, psychosocial, and social impairment ( 7 ). Child victims of maltreatment within the family may also suffer from poor school performance and impaired parent-child relationships ( 8 ).…”